title: Vertebral hemangioma: an important differential in the evaluation of locally aggressive spinal lesions.
abstract: METHODS
  A case report and a discussion of recent published data.
  
  
  OBJECTIVE
  To highlight the importance of vertebral hemangioma (VH) as a differential diagnosis in the evaluation of locally aggressive spinal lesions.
  
  
  BACKGROUND
  VH commonly occur as incidental findings, however, locally aggressive VH have been described. Difficulties in diagnosing these lesions are well reported and relate to changes in fat content causing uncharacteristic appearances on imaging. The management options for these lesions include a combination of observation, embolization, sclerotherapy, surgical decompression, or stabilization and radiotherapy.
  
  
  METHODS
  A 45-year-old patient who was previously well presented with back pain and rapidly progressive paraparesis. Imaging confirmed the presence of an extensive lesion centered within the right T3 vertebral pedicle with intrusion into the spinal canal. Urgent surgical decompression was undertaken and was complicated by extensive intraoperative hemorrhage requiring massive transfusion.
  
  
  RESULTS
  Histologically, the lesion was shown to be a cavernous VH with no evidence of malignancy. Following radiation oncology review, he was offered adjuvant radiotherapy to minimize the risks of recurrence. He achieved a near full neurologic recovery within 2 weeks and had a full recovery by 12 months.
  
  
  CONCLUSIONS
  VH should be considered in the evaluation of locally aggressive spinal lesions. Angiography is a useful adjunct in the evaluation of these lesions, both as a diagnostic and therapeutic tool. After diagnosed correctly a wide range of treatment options exist that may prevent the patient from undergoing major surgical resection and reconstruction procedures, which may be associated with high rates of morbidity.
authors.affiliation: Spinal Injuries Unit, Royal Adelaide Hospital, Adelaide, South Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Alexander
authors.forename: Adam
authors.initials: A
authors.lastname: Meir
authors.forename: Nikitas
authors.initials: N
authors.lastname: Vrodos
authors.forename: Yun-Hom
authors.initials: YH
authors.lastname: Yau
mesh_terms: D003937:Diagnosis, Differential; D018450:Disease Progression; D006392:Hemangioma, Cavernous / Q000150:complications / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D013125:Spinal Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery